BMJ 1995;311:587 (2 September)

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Hourly rate for some doctors proposed in Germany

The president of the German chamber of physicians has proposed that doctors who are contracted with the national health insurance scheme should be paid on an hourly basis. Dr Ellis Huber's scheme would replace the traditional system whereby doctors are paid on the basis of the number of patients they see and the services they perform. At present the official scale of fees for doctors lists about 2500 items, ranging from a simple consultation in a general practitioner's office to open heart surgery. About 1700 items are included in a scale list, which is part of the contract between doctors and the national health insurance plan.

The present system results in doctors seeing as many as 85 patients a day in their consulting rooms. Dr Huber believes that a sum of DM200 (£88) an hour would be appropriate for the average general practitioner. Of this, DM110 (£48) should go towards practice costs, such as rent, staffing, and technical equipment, while the remaining DM90 (£40) would be the doctor's fee. In Dr Huber's opinion his proposal would allow doctors to devote more time to patients.

Dr Frank Ulrich Montgomery, president of the Marburger Bund, the association of employed hospital doctors in Germany, conceded that there was "a grain of truth" in Dr Huber's criticism and that there were some "black sheep" among doctors, who tried to exploit the present system. But such cases were rare. Nor is the president of the association of doctors who participate in the national insurance scheme in Freiburg/South Baden enthusiastic about Dr Huber's idea. Dr Peter Schwoerer calculates that doctors with a lump sum of DM200 an hour would "certainly be better off" so long as they had to deal only with patients who needed a consultation and a few prescriptions. But doctors would begin to lose money as soon as more sophisticated diagnostic and therapeutic procedures were required. Overall the proposed scheme would be "hostile to patients." Dr Schwoerer also pointed out that his association was working on a new remuneration concept that mixed time related and service related fees and could reduce the number of items in the valuation scale list from 1700 to 1300.--HELMUT L KARCHER, medical writer, Munich


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